The effect of a hypoglycemia treatment protocol on glycemic variability in critically ill patients.

INTRODUCTION Hypoglycemia and glucose variability are independently associated with increased mortality in septic, surgical, and mixed intensive care unit (ICU) patients. Treatment of hypoglycemia with dextrose 50% can overcorrect blood glucose levels and increase glucose variability. The purpose of this study is to evaluate the effect of a hypoglycemia treatment protocol focused on minimizing glucose variability in critically ill patients. METHODS This retrospective analysis was conducted at a 772-bed community teaching hospital in Detroit, Michigan. A standardized nursing-driven hypoglycemia treatment protocol specific to critically ill patients was implemented. Glucose variability, amount of dextrose administered, subsequent glucose monitoring, hypoglycemia recurrence, and mortality were compared between pre- and postprotocol groups. RESULTS The coefficient of variability of blood glucose in the postprotocol group (n = 53) was decreased compared with the preprotocol group (n = 52), 40.9% versus 49.3%, respectively (P = .048). Dextrose usage was significantly reduced between groups (21.2 g preprotocol vs 11.5 g postprotocol; P < .001). The time to first blood glucose check was 36 minutes after protocol implementation compared to 61 minutes before the protocol (P = .003). Finally, the incidence of continued hypoglycemia following dextrose administration and ICU mortality was similar between groups. CONCLUSIONS Implementation of the hypoglycemia treatment protocol described led to a reduction in glucose variability, while still providing a safe and effective way to manage hypoglycemia in critically ill patients.